Erlotinib with Pemetrexed - 1248386

Hi ssflxl,

That's a combination my wife used for a while, with good results. In her case, she had been treated with Pemetrexed (Alimta) first-line, then with Erlotinib (Tarceva) as maintenance therapy, so when she combined the two drugs she had already been exposed to each of them previously. For someone who has not used either (and I realize that you have already been using Tarceva), I would wonder about using up two of the three FDA-approved second-line treatments all at once. Perhaps a trial in which some patients received the two drugs together while others received them sequentially would provide helpful data. In any event the trial you quoted does seem to offer additional evidence that the two drugs are not incompatible. I do wonder if in most cases one of the drugs is doing the heavy lifting, such that the patients in the trial who received both drugs were then guaranteed to get the drug that would be effective for them, while those who received one drug by luck of the draw may have gotten the treatment that was not as effective for them as if they had been assigned the other.

JimC
Forum moderator

My leading concern is with presuming that the combination given concurrently is better than the combination given sequentially. The fact that progression-free survival is longer with the combination is probably not nearly as relevant as overall survival. It's not just how you do with your first treatment or any single line of treatment, but how you do across the full range of treatments.

The other issue is that we've really moved beyond the time when "never-smoker" is a sufficient clinical marker. We now know that EGFR mutation status or other molecular markers are far more relevant than just smoking status, which is really a proxy for the higher probability of having a relevant mutation. But talking about results for never-smokers without teasing apart their molecular marker status has become almost meaningless -- it really comes down to molecular markers.

-Dr. West

As an NSCLC patient that has tested negative for over one hundred genetic and mutative factors, and as someone who is potentially beginning to fail on pemetrexed, I have yet to find any inquiry into pemetrexed that I would regard as "meaningless". Those of us with no markers, enjoy the narrative of even the most generic of explorations of pemetrexed combinations and alternatives.